The edition · ENT & Head and Neck Surgery
A nebulised tranexamic acid protocol cut return to theatre for post-tonsillectomy bleeds from 44% to 15%
Two quality improvement cycles at one children's hospital, 501 patients, and no increase in transfusion, readmission or complications. Alongside it: what the initial audiogram shape tells you about sudden hearing loss before you start steroids, and an epiglottopexy literature that has quietly grown a new indication.
The edition in brief
A quality improvement project at a children's hospital took 501 children presenting with post-tonsillectomy haemorrhage through two Plan-Do-Study-Act cycles introducing nebulised tranexamic acid, first informally and then as a standardised protocol. The proportion needing surgical control of bleeding fell from 43.9 per cent before the intervention to 29.8 per cent and then 15.2 per cent (P < .0001), a 65.4 per cent relative reduction, with no change in length of stay, transfusion rates, readmissions or tranexamic acid-related complications. In sudden sensorineural hearing loss, a retrospective cohort of 487 adults found complete recovery in 16.4 per cent overall but 50.0 per cent of those with an ascending audiogram, 25.2 per cent flat, 9.8 per cent descending and none of the total-deaf group; descending (OR 0.25, 95% CI 0.15 to 0.42) and total-deaf (OR 0.05, 0.01 to 0.22) configurations independently predicted worse outcome, with model AUC 0.78. A scoping review of 24 studies and 371 children found paediatric epiglottopexy consistently improved respiration with preserved swallowing and low complication and recurrence rates, and documented drug-induced sleep endoscopy expanding its indications to sleep-state-dependent epiglottic obstruction in refractory obstructive sleep apnoea. A prospective controlled study of 67 patients with laryngopharyngeal reflux disease found reduced salivary microbial diversity, raised elastase and higher salivary pH against 44 controls. And a machine learning tool trained on 270 high-risk neonates reached 85.2 per cent accuracy and an AUC of 87.1 per cent for predicting hearing loss, with NICU stay duration and family history the dominant predictors.
The shape of the first audiogram is prognosis, and it is available before treatment
Read the audiogram shape at the first visit and let it set what you tell the patient about recovery.
Epiglottopexy has acquired a new indication, and sleep endoscopy is why
In a child with apnoea that persists after adenotonsillectomy, look for epiglottic collapse on sleep endoscopy.
A machine learning tool for neonatal hearing loss, built on 270 infants
Prioritise follow-up by NICU duration and family history; the model itself is not ready for use.
Laryngopharyngeal reflux has a salivary signature, which is not yet a test
Interesting biology; keep diagnosing laryngopharyngeal reflux the way you do now.
The child who spits out one clot has already told you something
Do the preparation at the herald bleed — access, group and save, antiemetic, and a written escalation plan.
Nebulised tranexamic acid took paediatric post-tonsillectomy bleeds from 44% to 15% returning to theatre
Write and stock a nebulised tranexamic acid protocol for post-tonsillectomy bleeding — informal use was not enough.
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